Provider Demographics
NPI:1134767700
Name:GONZALEZ- ELEJALDEZ, ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GONZALEZ- ELEJALDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:NY
Mailing Address - Zip Code:14882-8944
Mailing Address - Country:US
Mailing Address - Phone:607-533-5070
Mailing Address - Fax:
Practice Address - Street 1:250 AUBURN RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:NY
Practice Address - Zip Code:14882-8944
Practice Address - Country:US
Practice Address - Phone:607-533-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405023363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health